Incidence and distribution pattern of pelvic and paraaortic lymph node metastasis in patients with stages IB, IIA, and IIB cervical carcinoma treatedwith radical hysterectomy

BACKGROUND. The incidence and distribution pattern of retroperitoneal lymph node metastasis in patients with cervical carcinoma should be investigated based on data from systematic pelvic lymph node (PLN) and paraaortic lymph node (PAN) dissection, so that a basis can be established for determining the site of selective lymph node dissection or sampling. METHODS, A total of 208 patients with Stages IB, IIA, and IIB cervical carc inoma who underwent radical hysterectomy and systematic pelvic and PAN diss ection were investigated for lymph node metastasis and histopathologic risk factors for lymph node metastasis. RESULTS, Fifty-three patients (25.5%) had lymph node metastasis. The obtura tor lymph nodes were most frequently involved, with a rate of 18.8% (39/208 ). Forty-nine of 53 node-positive patients had lymph node metastasis in the obturator, internal iliac, or common iliac lymph nodes. Of 26 solitary lym ph node metastases confined to one node group, 18 were in the obturator, 3 in the internal iliac, 3 in the parametrial, and 2 in the common iliac lymp h nodes. A multiple logistic regression analysis revealed that deep cervica l stromal invasion and lymph-vascular space invasion were related to PLN me tastasis. It was also shown that metastasis to bilateral PLNs (excluding th e common iliac lymph nodes) as well as metastasis to the common iliac lymph nodes were significantly related to PAN metastasis. CONCLUSIONS. The results of this study suggest that the obturator lymph nod es can be sentinel lymph nodes of cervical carcinoma. PAN metastasis appear s to occur secondarily to wide-spread PLN metastasis. These results provide a basis for determining the site of selective lymph node dissection and fo r estimating the existence of PAN metastasis from the pattern of metastasis in PLN in patients with cervical carcinoma. (C) 1999 American Cancer Socie ty.